Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy 4th Edition: Expert Consult Premium Edition - Enhanced Online Features and Print

Clinical Cardiac Pacing, Defibrillation, and Resynchronization Therapy......Page 1
Copyright......Page 2
Dedications......Page 3
Contributors......Page 4
Preface......Page 9
Video Contents......Page 10
Electric Circuit......Page 11
Inductance......Page 12
Determinants of the Resting Transmembrane Potential......Page 13
Voltage-Gated Channels......Page 14
Phase 0: Rapid Depolarization......Page 15
Myocardial Cell Electrical Properties......Page 16
Single-Cell Excitation by Electrical Stimulus......Page 17
Electric Potential Gradients and Currents for Stimulation and Defibrillation......Page 18
Anodal and Cathodal Stimulation......Page 19
Chronaxie, Rheobase, Energy, and Pulse Duration Thresholds......Page 21
Practical Application to Threshold Measurement......Page 22
? Strength-Interval Relationships......Page 23
Impedance at Electrode-Tissue Interface......Page 24
Charge Conduction and Transmembrane Potential Changes in Cardiac Pacing and Defibrillation......Page 25
Capacitance and Polarization......Page 26
Biphasic Stimulus Effect......Page 27
Capacitance Effect of Helmholtz Double Layer......Page 28
Relation of Electrode-Tissue Interface Capacitance to Polarization Voltage......Page 29
Capacitance and Electric Potential Gradients Related to Membrane Depolarization in Pacing and Defibrillation......Page 30
? Unipolar and Bipolar Stimulation......Page 31
? Constant-Current versus Constant-Voltage Stimulation......Page 32
Size of the Stimulating Electrode (Geometric Surface Area)......Page 34
Relationship of Electrode Size and Sensing Performance......Page 35
Electrode-Tissue Interface and Foreign Body Response......Page 36
Steroid-Eluting Electrodes......Page 38
Electrode Materials......Page 39
Physiologic and Pharmacologic Effects on Pacing......Page 40
? Biventricular Pacing......Page 41
? Adequate Margin of Safety......Page 42
Programming Voltage Versus Pulse Width for Maximum Pulse Generator Longevity......Page 43
? Conclusion......Page 44
References......Page 45
? Fibrillation......Page 48
Cellular Action Potential and Excitable Gap During Fibrillation......Page 49
Waveforms, Current Strength, and Distribution During Defibrillation......Page 50
Sawtooth Model......Page 53
Secondary Source Model......Page 54
Bidomain Model......Page 55
Effect of Defibrillating Shock Field on Cellular Action Potential......Page 56
Refibrillation Caused by Defibrillation Shock......Page 57
References......Page 61
Amplitude, Slew Rate, and Waveshape......Page 64
Atrial Electrograms during Rhythms Other Than Sinus......Page 66
Subcutaneous Electrocardiography......Page 67
Blanking and Refractory Periods......Page 68
Sensing Thresholds in Pacemakers......Page 70
Postpacing Automatic Adjustment of Sensitivity.......Page 72
Automatic Gain Control.......Page 73
“Sensing” Other Ventricular Electrograms......Page 74
Postventricular Atrial Blanking and Rejection of Far-Field R Waves......Page 75
? Ventricular Oversensing: Recognition and Troubleshooting......Page 76
T-wave Oversensing......Page 77
External Electromagnetic Interference......Page 82
Lead/Connector Problems......Page 83
Role of lead impedance.......Page 84
Detection Algorithms for Automatic Optimization of Pacemaker Function......Page 85
Algorithms to Reduce Ventricular Pacing......Page 86
? Basics of Detection of Ventricular Tachycardia/Fibrillation......Page 87
Ventricular Rate and Counting Methods......Page 90
Confirmation, Redetection, and Episode Termination......Page 91
Dual-Chamber Building Blocks......Page 93
Sudden Onset......Page 96
Oversensing of Pectoral Myopotentials.......Page 98
Supraventricular Tachycardia Soon after Shock.......Page 101
Operation for Atrial Rate Equal to Ventricular Rate......Page 103
Single-Chamber vs. Dual-Chamber Discriminators......Page 104
Features to Override Discriminators......Page 109
SVT-VT Discriminators in Redetection......Page 111
Zones and Zone Boundaries......Page 112
Duration for Detection of Ventricular Fibrillation......Page 114
Duration for Redetection......Page 116
Undersensing......Page 117
Intradevice Interactions......Page 119
Monitoring for Ventricular Tachycardia......Page 120
Detection of AT/AF for Atrial Therapy......Page 122
Detection Considerations for Atrial Shocks......Page 123
Implantable Subcutaneous Monitoring......Page 124
Sensing and Tachyarrhythmia Detection......Page 125
? Future Directions: Hemodynamic Sensors for ICDs......Page 129
References......Page 131
Lead Structure And Polarity......Page 135
Conductors......Page 137
Insulation......Page 138
Electrodes......Page 139
Fixation Mechanisms......Page 141
? Resynchronization Leads......Page 142
Lead Placement and Fixation Mechanisms......Page 143
Historical Evolution of ICD Leads......Page 144
ICD Lead Sensing Design......Page 145
Electrodes and High-Voltage Coils......Page 146
ICD Lead Connector Terminals......Page 147
Extraction Considerations......Page 148
ICD Lead Failure......Page 149
References......Page 150
Classification of Sensors......Page 152
Technical Classification......Page 153
St. Jude Medical (Identity, Vitality, Zephyr, Accent).......Page 155
Clinical Results of Activity Sensors......Page 156
Clinical Experience of MV Sensor Pacemakers......Page 157
Sensor and Algorithm......Page 158
Sensor and Algorithm......Page 159
Boston Scientific (Insignia, Pulsar Max, Altrua)......Page 160
Chronotropic Incompetence......Page 162
? Acute Decompensated Heart Failure......Page 164
Limitations of Symptoms, Signs, and Investigations......Page 165
? Sensors for Heart Failure......Page 166
Heart Rate Variability......Page 167
Percentage Biventricular Pacing......Page 168
Feasibility Study......Page 169
Clinical Outcome Studies......Page 170
Pulmonary Arterial Pressure Sensor......Page 171
Device Description......Page 172
Clinical Outcome Studies......Page 173
Multipolar Impedance......Page 176
Minute Ventilation......Page 177
? Combined Heart Failure Diagnostics......Page 178
? Conclusion......Page 179
References......Page 180
Electrolyte......Page 183
Energy and Energy Density......Page 184
Self-Discharge.......Page 185
The Battery and Longevity of Pulse Generator......Page 186
Considerations for Longevity of ICDs......Page 187
False Triggering......Page 188
Lithium/Carbon Monofluoride Battery......Page 189
Comparison of Pacemaker and Defibrillator Batteries......Page 190
Charge Time–Optimized Li/SVO ICD Batteries.......Page 191
Safety......Page 192
Principles of Operation......Page 193
Energy Storage......Page 194
Stacked-plate Aluminum Electrolytic Construction.......Page 195
Internal Resistance.......Page 196
Energy Losses in Defibrillators......Page 197
References......Page 198
If Manipulations......Page 199
? Cell Therapy Strategies......Page 201
References......Page 202
NASPE/BPEG Generic (NBG) Pacemaker Code......Page 203
NASPE/BPEG Defibrillator (NBD) Code......Page 204
? Headers......Page 205
? Conclusion......Page 206
References......Page 207
Electrical Activation During Sinus Rhythm......Page 208
Mechanical Activation During Sinus Rhythm......Page 209
Abnormal Contraction Patterns During Left Bundle Branch Block and Right Ventricular Pacing......Page 211
Effect of Left Bundle Branch Block and Right Ventricular Pacing on Local Energetic Efficiency......Page 212
Effect of Asynchronous Activation on Systolic and Diastolic Pump Function......Page 214
Electrical and Structural Remodeling......Page 215
Correction of Bradycardia by Pacing......Page 216
Patients with Normal Left Ventricular Function......Page 218
Patients with Depressed Left Ventricular Function......Page 220
Clinical Consequences of Asynchronous Activation......Page 222
Alternative-Site Ventricular Pacing.......Page 223
? Strategies to Restore Synchrony: Cardiac Resynchronization Therapy......Page 224
Physiology of Cardiac Resynchronization Therapy......Page 225
Determination of Mechanical Asynchrony......Page 226
The Site of Pacing......Page 227
Atrial Pacing and Sensing......Page 228
Atrioventricular Optimization......Page 230
? Pacemaker Syndrome......Page 231
References......Page 234
Ventricular Pacing with Rate Response Versus Dual-Chamber Pacing (VVIR vs. VDD/DDD/DDDR)......Page 239
Dual-Chamber Pacing in Chronotropic Incompetence or Paroxysmal Atrial Fibrillation: DDD(R) with Mode Switching......Page 240
Dual-Chamber Pacing with Versus Without Rate Response (DDD vs. DDDR)......Page 241
Critical Appraisal of Danish Study......Page 242
Mortality......Page 243
Randomized Studies......Page 244
Mode Selection Trial in Sinus Node Dysfunction (MOST)......Page 245
Critical Appraisal.......Page 246
Critical Appraisal.......Page 247
? Atrial Single-Chamber Versus Dual-Chamber Pacing: Clinical Trials......Page 248
? Dual-Chamber Versus Ventricular Pacing in Defibrillator Patients......Page 252
Other Issues......Page 254
? Role of Prevention of Unnecessary Right Ventricular Pacing......Page 255
? Trials Evaluating Right Ventricular Versus Biventricular Pacing......Page 257
? Current Guidelines on Pacing Mode Selection......Page 258
References......Page 259
? Quality of Life......Page 262
Cost......Page 263
Identifying Individuals at Risk......Page 264
? Evolution of ICD Therapy......Page 265
Antiarrhythmics versus Implantable Defibrillators Trial......Page 266
Canadian Implantable Defibrillator Study......Page 267
Multicenter Unsustained Tachycardia Trial......Page 268
Second Multicenter Automatic Defibrillator Implantation Trial......Page 269
Sudden Cardiac Death–Heart Failure Trial......Page 271
Patients with Left Ventricular Dysfunction in Specific Circumstances......Page 273
Defibrillators in Acute Myocardial Infarction Trial......Page 274
Nonrandomized Studies of Icd Therapy: a Note of Caution......Page 275
Arrhythmogenic Right Ventricular Cardiomyopathy......Page 276
Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy......Page 277
Defibrillators to Reduce Risk by Magnetic Resonance Imaging Evaluation......Page 278
Efficacy of ICD in Patients with Non-Ischemic Systolic Heart Failure Trial......Page 279
Real-World Effectiveness......Page 280
References......Page 281
? Studies of CRT in the Acute Setting: How Does It Work?......Page 284
? Controlled Trials of CRT Devices......Page 286
Multisite Stimulation in Cardiomyopathy Studies......Page 287
CONTAK CD and Multicenter InSync ICD Randomized Clinical Evaluation......Page 288
Comparison of Medical Therapy, Pacing, and Defibrillation on Heart Failure......Page 289
Cardiac Resynchronization-Heart Failure Study......Page 290
Multi-Center Automatic Defibrillator Implantation Trial–CRT......Page 294
? Procedural Safety and Left Ventricular Lead Performance......Page 295
ESTEEM-CRT and Echo-CRT......Page 296
DECREASE-HF and Rhythm-II-ICD......Page 297
Atrioventricular Optimization Studies......Page 298
Predictors of Response to CRT......Page 299
BLOCK-HF and BioPace Studies......Page 300
? Managing Heart Failure with CRT Devices: Additional Device Features......Page 301
References......Page 302
Clinical Electrophysiology......Page 305
Clinical Presentation......Page 309
Pacing and Survival......Page 310
Detection of Atrial Fibrillation......Page 311
Pacing Mode in Prevention of Atrial Fibrillation......Page 312
Pacing Algorithms in Prevention of Atrial Fibrillation......Page 313
Pacing Algorithms in Termination of Atrial Fibrillation......Page 316
Site-Specific Atrial Pacing for Atrial Fibrillation Prevention......Page 317
Relationship Between Stroke Risk and Atrial Fibrillation Burden/Duration......Page 318
Risk of Atrial Fibrillation......Page 319
Risk of Heart Failure......Page 320
AAIsafeR Mode......Page 321
Clinical Outcomes......Page 322
AAIR Pacing......Page 323
References......Page 325
Electrocardiography......Page 328
Electrophysiologic Study......Page 332
Identifying Patients at Risk for AV Block......Page 333
First-Degree AV Block......Page 334
Paroxysmal AV Block......Page 335
Congenital AV Block......Page 336
Inherited Conduction System Diseases......Page 337
Acquired Causes of AV Block......Page 338
? Indications for Permanent Pacing in Chronic Atrioventricular Block......Page 342
Incidence......Page 343
Progression of AV Block......Page 344
Impact of Thrombolytic Therapy......Page 346
Electrophysiologic Studies in AV Block and Bundle Branch Block......Page 348
Temporary Pacing......Page 349
Permanent Pacing......Page 350
? Selection of Pacing Mode in Atrioventricular Block......Page 351
VDD(R) Pacing......Page 352
Optimal Atrioventricular Interval Programming......Page 353
Site-Specific Ventricular Pacing in AV Block......Page 355
? Automatic Capture Verification and Pacing Output Management......Page 358
? Summary......Page 360
References......Page 361
Other Therapies......Page 366
Physical Diagnosis with Carotid Sinus Massage......Page 367
Complications......Page 368
Physiology......Page 369
Physical Counterpressure Maneuvers......Page 370
Evidence of Clinical Benefit......Page 371
Vasovagal Syncope International Study.......Page 372
Second Vasovagal Pacemaker Study.......Page 373
Patient Selection......Page 374
Contractility Sensors......Page 375
References......Page 376
? Shock Waveform......Page 379
Defibrillation Testing......Page 382
Risks of Defibrillation Testing......Page 383
? Postimplant Programming of Tachyarrhythmia Therapy......Page 384
Recommendations......Page 385
References......Page 386
Aborted Cardiac Arrest......Page 388
Risk Stratification......Page 389
? General Considerations......Page 390
? Antibradycardia Therapy in Long QT Syndrome......Page 391
Risk of Never Using Device......Page 392
Strategies to Avoid Complications......Page 394
References......Page 395
Sinus Node Dysfunction......Page 398
Congenital Complete Heart Block......Page 399
Other Indications......Page 400
Generator Mode Selection......Page 401
General Characteristics......Page 404
Rate-Responsive Pacing......Page 405
Summary......Page 406
Endocardial versus Epicardial Pacing......Page 407
Unipolar versus Bipolar Pacing......Page 409
Epicardial Electrode Types......Page 410
Endocardial Electrode Types......Page 411
Summary......Page 413
Endocardial Implantation Techniques......Page 414
Acute Electrode Evaluation......Page 415
Pacemaker Clinic Visit......Page 417
Exercise Testing......Page 418
Ambulatory Electrocardiographic Monitoring......Page 419
Remote and Transtelephonic Pacemaker Monitoring......Page 420
Late Follow-Up......Page 421
Patient Selection......Page 422
Implantation Approaches......Page 423
Programming Considerations......Page 424
Follow-Up Procedures......Page 425
? Cardiac Resynchronization Therapy in Patients with Structural Cardiac Disease......Page 426
Implications for Health Care Providers......Page 428
Children with Implantable Cardioverter-Defibrillators......Page 429
References......Page 430
? Optimal Defibrillation Configuration......Page 433
? Other Investigator Approaches to Subcutaneous Defibrillation......Page 435
? Prelude to First Use of Stand-Alone Subcutaneous Defibrillator......Page 436
? Future of Subcutaneous Defibrillators......Page 437
References......Page 438
? Totally Self-Contained Intracardiac Pacemaker......Page 439
Acoustic (Ultrasound) Energy......Page 440
Implantable Leadless Pacing System......Page 442
? Biologic Pacemaker......Page 444
References......Page 445
Implanting Physician or Surgeon......Page 446
Implantation Facility and Equipment......Page 447
Preoperative Planning......Page 450
Inpatient Versus Outpatient Procedure......Page 451
Preoperative Orders......Page 452
Site Preparation and Draping......Page 453
Antibiotic Prophylaxis and Wound Irrigation......Page 455
Anatomic Approaches for Implantation......Page 456
Cephalic Venous Access......Page 459
Subclavian Venous Access......Page 460
Axillary Venous Access (see Box 21-4)......Page 462
Sheath Set Technique with Cutdown Approach.......Page 471
Complications of Percutaneous Venous Access and Blind Subclavian Puncture......Page 472
Placement of the Ventricular Electrode......Page 473
Placement of Atrial Electrodes......Page 477
Upgrading Techniques......Page 479
Securing Leads, Creating Pockets, and Closure......Page 481
Immediate Postoperative Care......Page 484
Use of the Iliac Vein......Page 485
Alternative (Cosmetic) Locations for Pacemaker Pocket......Page 486
Transvenous Lead Placement in Infants and Children......Page 488
Alternatives to Radiography During Implantation......Page 489
Alternatives to Transvenous Lead Placement......Page 490
? Implantation of Implantable Cardioverter-Defibrillators......Page 493
Personnel and Equipment......Page 494
Epicardial Approach......Page 496
Left Subcostal Approach.......Page 497
Endocardial Approach......Page 498
Tunneling Techniques......Page 499
Subcutaneous Defibrillation Electrodes......Page 500
Azygos Vein Defibrillation Coil......Page 501
Subcutaneous Implantable Cardioverter-Defibrillator......Page 502
Pectoral Pocket......Page 503
Submuscular Pectoral Pocket......Page 504
Selective Site Pacing......Page 506
Right Atrium.......Page 508
Radiographic Anatomy.......Page 510
Atrial Septal Pacing......Page 512
Right Ventricular Selective Site Pacing......Page 513
Direct His Bundle Pacing......Page 514
The Future of Selective Site Pacing......Page 515
References......Page 516
Extra Support Wires......Page 519
PhilosophicAL Approach......Page 520
? Left Ventricular Lead Position and Response......Page 522
? Guide Support–Based Delivery System......Page 525
Previous Approach......Page 527
? Left Ventricular Lead Implantation with Interventional Techniques......Page 529
Pay Careful Attention to Orientation of Instrument Table During Procedural Stages......Page 532
Axillary versus Subclavian Access.......Page 533
Response to Subclavian Obstruction in Patient with Preexisting Leads......Page 535
Why Peel-away Sheaths Are Not Provided for CS Access.......Page 536
Limitation of Contrast Method.......Page 538
Success with and Failure Without Contrast.......Page 540
Locating CS Os with Contrast Injection System.......Page 541
Anatomy Surrounding CS Os as Defined by Contrast Injection......Page 544
Coronary Venous Anatomy......Page 550
Occlusive Coronary Sinus Venography......Page 551
Selective Injection of Anterior or Middle Cardiac Vein.......Page 553
Basic Patterns of Coronary Venous Anatomy......Page 557
Coronary Sinus Empties into Left Atrium.......Page 558
Selecting Target Vein......Page 561
Method of Fixation.......Page 563
Advance Guide over Selector/Wire Rail into Target Vein for Lead Delivery.......Page 571
Lead Length.......Page 575
Hub Design.......Page 581
Stylet Characteristics.......Page 582
Perforation......Page 588
Electrophysiology Versus Open-Lumen Catheter With Contrast FOR Implantation......Page 590
Balloon-Induced Trauma.......Page 591
Radiation Exposure......Page 592
? Left Ventricular Lead Delivery Systems......Page 594
Acuity Spiral, EasyTrak 2 and 3......Page 601
Acuity Spiral.......Page 602
Medtronic......Page 603
StarFix Lead......Page 611
Quartet......Page 613
Comparison with Transvenous Approach......Page 614
Equipment......Page 616
References......Page 619
? Interventional versus Electrophysiologic Approach......Page 621
Training......Page 622
Hydration Protocol......Page 623
N-Acetylcysteine......Page 624
Catheter Manipulation and Contrast Injection......Page 625
More Compliant Balloons......Page 626
Technique Considerations.......Page 627
? Crossing Obstructed or Occluded Vein in Patients with Preexisting Leads......Page 628
Crossing an Occluded “Subclavian” vein......Page 629
Femoral Extraction with Wire in Stylet Lumen Followed by Venoplasty.......Page 632
Radiofrequency Guidewire.......Page 635
Laser Crossing of Total Occlusions.......Page 638
Preventing Complications.......Page 641
Total Occlusions in Patients Without Implanted Leads......Page 642
Venoplasty vs. Progressively Larger Dilators......Page 649
Balloons for Subclavian Vein Venoplasty......Page 650
Kevlar Balloons and Focused-Force Venoplasty......Page 655
Training Required to Perform Venoplasty......Page 656
The Buddy Wire Technique......Page 658
Background: Coronary Sinus and Coronary Vein Venoplasty......Page 659
Optimizing Guide Support......Page 663
Focused-Force and Cutting-Balloon Venoplasty......Page 664
Venoplasty of Main Coronary Sinus......Page 665
Venoplasty of Small or Stenotic Target Veins......Page 667
Venoplasty of Collaterals Between Two Adjacent Veins for Retrograde Left Ventricular Lead Placement......Page 674
Using Anchor Balloons to Facilitate Left Ventricular Lead Implantation......Page 684
Left Ventricular Lead Placement Using Coronary Balloon as Anchor......Page 696
Recovering Coronary Sinus Access.......Page 697
Snare for Left Ventricular Lead Placement......Page 698
Antidromic Snare for LV Lead Implantation: Insert the LV Pacing Lead over the Distal End of the Wire in Difficult Anatomy Where the Wire Cannot Be Delivered into Target Vein Antegrade, But Still Want to Insert Lead into Target Vein Antegrade.......Page 701
Summary......Page 702
Transseptal Left Ventricular Lead implantation......Page 703
Interventional Approach to Azygos Vein Coil Placement......Page 714
References......Page 720
Documentation of Pacemaker Pulse Generator Battery Depletion......Page 722
Indicators for Replacement of ICD Generators......Page 723
Documentation of Lead Malfunction......Page 724
Special Issues for ICD Leads......Page 725
Detection of Need for Reoperation for Other Reasons......Page 726
Upgrading to Higher-Energy Device or Addition of Hardware for Inadequate Defibrillation Threshold.......Page 727
Complications of Pacemaker or ICD Implantation That Require Reoperation.......Page 728
Radiographic or Fluoroscopic Identification of Leads.......Page 729
Testing the Sensing and Pacing Capabilities of Long-Term Leads......Page 730
Examining Structural Integrity of Leads and Lead-Generator Interface......Page 731
? Surgical Considerations......Page 732
Specific Techniques......Page 733
Managing Venous Stenosis......Page 735
Lead Connectors......Page 736
Adapters......Page 737
Tools......Page 738
Approach to the Eroding Device......Page 739
? Intervention for Acute Problems......Page 740
References......Page 741
Lead Dislodgment......Page 744
Hemothorax......Page 745
? Pain......Page 746
Bacteriology......Page 747
References......Page 749
Infection......Page 750
Noninfected Systems......Page 752
Creation of a Conduit......Page 754
? Risks and Outcomes......Page 755
Patient Information and Preparation......Page 756
Tissue Closure......Page 757
Direct Traction......Page 758
Countertraction......Page 759
Mechanical Sheaths......Page 760
Excimer Laser Sheath......Page 761
Electrosurgical Dissection Sheaths......Page 762
Locking Stylets......Page 763
? Lead Extraction Approaches......Page 764
Complications.......Page 767
Remote Vein Sites......Page 768
Femoral Approach......Page 769
Transatrial Approach......Page 770
Open-Heart Procedure......Page 771
? Special Situations......Page 772
References......Page 773
Pacing and Defibrillation Leads......Page 774
Venous Anatomy for Localization of Lead Positions......Page 775
Atrial Lead Positions.......Page 783
Ventricular Lead Positions.......Page 784
Identification of Possible Pacemaker Lead Malfunction.......Page 785
Identification of Lead Malfunction.......Page 796
Persistent Left-Sided Superior Vena Cava......Page 797
Corrected L-Transposition of Great Arteries......Page 800
Alternative-Site Pacing......Page 804
Detection of Acute Complications......Page 806
Pericardial Effusion, Cardiac Perforation, and Cardiac Tamponade......Page 809
Pericardial Effusion......Page 810
? Magnetic Resonance Imaging......Page 811
References......Page 812
Ventricular Blanking and Refractory Periods......Page 814
Ventricular Oversensing and Undersensing......Page 815
Atrial Periods and Hysteresis......Page 816
Dual-Chamber Timing Cycles......Page 817
Crosstalk and Ventricular Safety Pacing.......Page 818
Atrioventricular Interval Hysteresis.......Page 819
Postventricular Atrial Refractory Period......Page 821
Upper Rate Behavior......Page 823
Lower Rate Behavior: Atrial- versus Ventricular-Based Timing......Page 824
Hemodynamics of Exercise and Rate......Page 826
Noise Response......Page 828
Pacemaker-Mediated Tachycardia Algorithms......Page 830
Atrial Flutter Response......Page 831
Prevention of Atrial Fibrillation......Page 833
Managed Ventricular Pacing......Page 834
DDI Mode......Page 836
Goals of Biventricular Pacing......Page 837
Interventricular Timing Delay......Page 838
Biventricular Sensing and Biventricular Pacing......Page 839
Upper Rate Behavior......Page 840
Loss of Biventricular Pacing......Page 841
? Timing Cycles: Pacing Algorithms in Implantable Cardioverter-Defibrillators......Page 842
References......Page 844
Battery Status......Page 845
Lead Status......Page 847
Event Marker Telemetry......Page 850
Event Marker Displays......Page 851
Event Marker Limitations......Page 852
Electrogram Telemetry......Page 853
Event Counter Telemetry......Page 855
Total System Performance Counters......Page 856
Subsystem Performance Counters......Page 857
? Pacing System Malfunction......Page 859
Historical Clues......Page 861
Physical Examination and Telemetry......Page 865
Failure of Output (No Artifact Present)......Page 869
Failure to Capture (Artifact Present)......Page 873
Failure to Sense......Page 875
Crosstalk Inhibition......Page 877
Prevention of Crosstalk.......Page 878
Prevention of Crosstalk Sequelae.......Page 879
Sensor-Driven Tachycardia.......Page 880
Endless-loop Tachycardia.......Page 881
Prevention.......Page 882
Cross-Stimulation......Page 884
Repetitive Non-Reentrant Ventriculoatrial Synchronous Rhythm......Page 885
? Conclusion......Page 886
References......Page 887
Device Telemetry......Page 890
Radiographic Evidence......Page 892
? Multiple Shocks......Page 893
Failure to Convert Ventricular Tachycardia or Ventricular Fibrillation......Page 905
Failure to Detect Ventricular Tachycardia or Ventricular Fibrillation......Page 907
Problems with Pacing......Page 908
References......Page 909
Ventricular Level......Page 912
Mechanistic Basis for Development of Asynchronous Heart Failure Caused by Ventricular Conduction Delay......Page 914
Improved Ventricular Mechanics from Reduced Ventricular Conduction Delay......Page 916
Reverse Volumetric Left Ventricular Remodeling......Page 918
Reduction in Functional Mitral Regurgitation......Page 919
Pulse Generators......Page 921
Pacing Modes......Page 923
Determining LV and RV Capture: Importance of Electrocardiography......Page 924
Automatic Adjustment of Left Ventricular Pacing Output......Page 926
Operating Details.......Page 927
Methods to Guarantee Ventricular Electromechanical Resynchronization......Page 928
Characterization of Ventricular Activation during LBBB Using QRS Hieroglyphic Analytic Framework Derived from Surface ECG.......Page 929
Quantification of Left Ventricular Scar.......Page 930
CRT Programming to Generate Maximum Evidence of Ventricular Activation Fusion......Page 932
Methods to Guarantee Optimal Atrioventricular Resynchronization......Page 937
Effects of Pacemaker Atrioventricular Interval on Loading Conditions, Diastolic Function, and Systolic Function......Page 939
Optimization of AV Resynchronization......Page 944
Left Ventricular Inflow Analysis.......Page 945
Noninvasive Hemodynamic Monitoring......Page 948
Comparison of Methods for Optimizing AV Resynchronization......Page 949
Atrial Pacing/Pacemaker AVI Interaction: Loading Conditions and Diastolic/Systolic Function......Page 950
Interventricular Timing Considerations......Page 953
Implications of Spontaneous and Pacing-Induced Conduction Blocks During Biventricular Pacing......Page 959
Implementation of Sequential Ventricular Timing in CRT Systems......Page 960
Clinical Experience with Sequential Ventricular Stimulation......Page 962
SmartDelay Operating Specifics.......Page 964
Operating Constraints of SmartDelay Optimization.......Page 966
QuickOpt Operating Specifics.......Page 967
Limitations of QuickOpt.......Page 968
Atrial Undersensing......Page 969
Atrial Oversensing......Page 971
Atrial Tachyarrhythmias with Rapid Ventricular Conduction......Page 972
Frequent Ventricular Premature Beats......Page 974
Loss of Left Ventricular Capture......Page 975
Pacing Operation–Related Problems......Page 977
Ventricular Oversensing......Page 979
Ventricular Proarrhythmia During Left Ventricular Pacing......Page 981
References......Page 985
Technologic Advances......Page 988
Patient-Activated Remote Monitoring......Page 989
TRUST Trial......Page 990
Device Clinic......Page 993
Patient Aspects......Page 999
? Lead and Device Performance......Page 1000
Integration of Services......Page 1002
References......Page 1003
Other Sources of Radiated EMI......Page 1005
? Sources of Knowledge Regarding Electromagnetic Interference......Page 1006
? Pacemaker and ICD Responses to Electromagnetic Interference......Page 1007
Triggering of Rapid or Premature Pacing......Page 1008
Noise-Reversion Mode......Page 1009
Electric (Power-On) Reset......Page 1010
Determinants of Electromagnetic Interference......Page 1011
Cellular Telephones, Wireless Communication Devices, Personal Media Players......Page 1012
Electronic Article Surveillance Devices......Page 1013
Alternative Medicine Devices......Page 1014
Magnetic Resonance Imaging......Page 1015
Electrosurgery......Page 1019
Direct-Current Cardioversion and Defibrillation......Page 1022
Radiofrequency Ablation......Page 1023
Dental Equipment......Page 1024
Radiotherapy......Page 1025
References......Page 1026
Generator Performance and Mechanisms of Malfunction......Page 1029
Lead Performance and Mechanisms of Malfunction......Page 1030
Surveillance of Device Performance......Page 1032
Number, Rate, and Reasons for Advisory.......Page 1034
Communication After Device Malfunction Identified......Page 1035
Overview and Clinician Responsibilities......Page 1036
Risks of Generator Replacement and Lead Placement......Page 1037
Device and Patient Factors Impacting Clinical Decision Making......Page 1038
References......Page 1039
? Ethical and Legal Principles Underlying CIED Deactivation......Page 1041
Rights and Responsibilities of Clinicians for Whom Deactivation Is Counter to Their Personal Beliefs......Page 1043
Discussion of Device Deactivation with Overall Goals of Care......Page 1044
Benefits/Burdens of Ongoing Device Therapy; Consequences/Uncertainties of Deactivation......Page 1045
Palliative Care Specialists......Page 1046
? Logistics of CIED Deactivation......Page 1047
? Device Deactivation in the Pediatric Patient......Page 1048
References......Page 1049
A......Page 1051
B......Page 1054
C......Page 1056
D......Page 1060
E......Page 1062
F......Page 1064
H......Page 1065
I......Page 1066
K......Page 1068
L......Page 1069
M......Page 1071
N......Page 1072
P......Page 1073
R......Page 1077
S......Page 1079
T......Page 1082
V......Page 1083
Z......Page 1085